Healthcare Provider Details

I. General information

NPI: 1124845680
Provider Name (Legal Business Name): D. FUNSCH JR, M.D., PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2024
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

885 3RD AVE FL 28
NEW YORK NY
10022-4834
US

IV. Provider business mailing address

885 3RD AVE FL 28
NEW YORK NY
10022-4834
US

V. Phone/Fax

Practice location:
  • Phone: 929-650-3990
  • Fax: 929-996-6230
Mailing address:
  • Phone: 929-650-3990
  • Fax: 929-996-6230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. FAIGE MILLER
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 929-650-3990